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Asanuma K, Tsujii M, Hagi T, Nakamura T, Uchiyama T, Adachi R, Nakata K, Kataoka T, Sudo A. Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0. Front Surg 2024; 11:1357265. [PMID: 38505411 PMCID: PMC10948408 DOI: 10.3389/fsurg.2024.1357265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer. Methods A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated. Results Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104). Discussion Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.
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Affiliation(s)
- Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu City, Japan
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Asanuma K, Tsujii M, Hagi T, Nakamura T, Kita K, Shimamoto A, Kataoka T, Takao M, Sudo A. Full-thickness chest wall resection for malignant chest wall tumors and postoperative problems. Front Oncol 2023; 13:1104536. [PMID: 37152065 PMCID: PMC10160664 DOI: 10.3389/fonc.2023.1104536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/20/2023] [Indexed: 05/09/2023] Open
Abstract
Background Chest wall malignant tumor (including primary and metastatic lesions) is rare, representing less than 5% of all thoracic malignancies. Local control of chest wall malignancies requires wide resection with tumor-free margins. These requirements increase the risk of thoracic cavity failure and subsequent pulmonary failure. The restoration strategy for chest wall defects comprises chest wall reconstruction and soft-tissue coverage. Various reconstruction methods have been used, but both evidence and guidelines for chest wall reconstruction remain lacking. The purposes of this study were to collate our institutional experience, evaluate the outcomes of full-thickness chest wall resection and reconstruction for patients with chest wall malignant tumor, and identify problems in current practice for chest wall reconstruction with a focus on local control, complications, pulmonary function and scoliosis. Methods Participants comprised 30 patients with full-thickness chest wall malignant tumor who underwent chest wall resection and reconstruction between 1997 and 2021 in Mie University Hospital. All patients underwent chest wall resection of primary, recurrent or metastatic malignant tumors. A retrospective review was conducted for 32 operations. Results Recurrence was observed after 5 operations. Total 5-year recurrence-free survival (RFS) rate was 79.3%. Diameter ≥5 cm was significantly associated with poor RFS. The postoperative complication rate was 18.8%. Flail chest was observed with resection of ≥3 ribs in anterior and lateral resections or with sternum resection without polyethylene methylmethacrylate reconstruction. Postoperative EFV1.0% did not show any significant decrease. Postoperative %VC decreased significantly with resection of ≥4 ribs or an area of >70 cm2. Postoperative scoliosis was observed in 8 of 28 patients. Posterior resection was associated with a high prevalence of scoliosis (88.9%). Conclusion With chest wall reconstruction, risks of pulmonary impairment, flail chest and scoliosis were significantly increased. New strategies including indications for rigid reconstruction are needed to improve the outcomes of chest wall reconstruction.
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Affiliation(s)
- Kunihiro Asanuma
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
- *Correspondence: Kunihiro Asanuma,
| | - Masaya Tsujii
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Tomoki Nakamura
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Kouji Kita
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery, School of medicine, Mie University, Tsu, Japan
| | - Takeshi Kataoka
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, School of medicine, Mie University, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
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Aramini B, Masciale V, Radaelli LFZ, Sgarzani R, Dominici M, Stella F. The sternum reconstruction: Present and future perspectives. Front Oncol 2022; 12:975603. [PMID: 36387077 PMCID: PMC9649912 DOI: 10.3389/fonc.2022.975603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022] Open
Abstract
Sternectomy is a procedure mainly used for removing tumor masses infiltrating the sternum or treating infections. Moreover, the removal of the sternum involves the additional challenge of performing a functional reconstruction. Fortunately, various approaches have been proposed for improving the operation and outcome of reconstruction, including allograft transplantation, using novel materials, and developing innovative surgical approaches, which promise to enhance the quality of life for the patient. This review will highlight the surgical approaches to sternum reconstruction and the new perspectives in the current literature.
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Affiliation(s)
- Beatrice Aramini
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
- *Correspondence: Beatrice Aramini,
| | - Valentina Masciale
- Cell Therapy Laboratory, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Federico Zini Radaelli
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Rossella Sgarzani
- Center of Major Burns, Plastic Surgery Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Massimo Dominici
- Cell Therapy Laboratory, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Stella
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
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Divisi D, Tosi D, Zaccagna G, De Vico A, Diotti C, Crisci R. Case Report: A New Tool for Anterior Chest Wall Reconstruction After Sternal Resection for Primary Or Secondary Tumors. Front Surg 2021; 8:691945. [PMID: 34355015 PMCID: PMC8331331 DOI: 10.3389/fsurg.2021.691945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
Sternal resection and anterior chest wall reconstruction techniques for malignant processes are not always standardized. We report an innovative method of sternal osteosynthesis in two patients, 65-year-old and 41-year-old women, with Ewing's sarcoma, and infiltrating thymoma, respectively. The first case manifested itself as a voluminous palpable mass while the second case was characterized for a paramediastinal mass widely extended to the anterior chest wall. Reconstruction with titanium mesh allowed the quick restoration of parietal stability, facilitating respiratory dynamic and recovery of patients.
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Affiliation(s)
- Duilio Divisi
- University of L'Aquila, Department of MeSVA, Thoracic Surgery Unit, "Giuseppe Mazzini" Hospital, Teramo, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Gino Zaccagna
- University of L'Aquila, Department of MeSVA, Thoracic Surgery Unit, "Giuseppe Mazzini" Hospital, Teramo, Italy
| | - Andrea De Vico
- University of L'Aquila, Department of MeSVA, Thoracic Surgery Unit, "Giuseppe Mazzini" Hospital, Teramo, Italy
| | - Cristina Diotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Roberto Crisci
- University of L'Aquila, Department of MeSVA, Thoracic Surgery Unit, "Giuseppe Mazzini" Hospital, Teramo, Italy
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Bilko SJ, Veytsman S, Amsellem PM, Chow RS. Ventilatory failure in a cat following radical chest wall resection for feline injection site sarcoma. JFMS Open Rep 2021; 7:20551169211026921. [PMID: 34350025 PMCID: PMC8287376 DOI: 10.1177/20551169211026921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Case summary A 12-year-old spayed female domestic shorthair cat presented for chest wall
resection and radiation therapy following incomplete surgical excision of a
feline injection site sarcoma. A CT scan for surgical planning was performed
under general anesthesia and showed extensive tumor infiltration of the soft
tissues of the right thorax. The cat recovered uneventfully from this
anesthetic event. Nineteen days later, the patient was reanesthetized for
forequarter amputation plus radical chest wall resection, including ribs 3–8
and all associated soft tissues plus adjacent spinous processes.
Postoperatively, the patient developed acute respiratory failure secondary
to hypoventilation. The cat was mechanically ventilated for 12 h prior to
being successfully weaned from the ventilator. However, the improvement was
transient and mechanical ventilation was reinitiated 6 h later owing to
respiratory fatigue. On the second day, the cat developed unexplained
central nervous system signs and was euthanized. Relevance and novel information To our knowledge, this is the first case report to describe ventilatory
failure secondary to radical chest wall resection in a cat. Hypoventilation
with subsequent need for mechanical ventilation is a potential complication
that should be considered during preoperative planning in patients requiring
extensive chest wall resections.
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Affiliation(s)
- Samantha J Bilko
- Department of Veterinary Clinical Sciences, University of Minnesota Veterinary Medical Center, St Paul, MN, USA
| | - Stan Veytsman
- Department of Veterinary Clinical Sciences, University of Minnesota Veterinary Medical Center, St Paul, MN, USA
| | - Pierre M Amsellem
- Department of Veterinary Clinical Sciences, University of Minnesota Veterinary Medical Center, St Paul, MN, USA
| | - Rosalind S Chow
- Department of Veterinary Clinical Sciences, University of Minnesota Veterinary Medical Center, St Paul, MN, USA
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Abdel Jalil R, Abou Chaar MK, Al-Qudah O, Kakish H, Elfar S. Chest wall and diaphragm reconstruction; a technique not well established in literature - case report. J Cardiothorac Surg 2021; 16:196. [PMID: 34243804 PMCID: PMC8272294 DOI: 10.1186/s13019-021-01577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/03/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of such etiology combined with chemo-radiotherapy. In order to maintain intact respiratory function, chest wall reconstruction must be performed whenever resection is done. Herein, we present a case of chest wall tumor that necessitated three ribs and part of hemidiaphragm resection and reconstruction with optimal post-operative results. CASE PRESENTATION A 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene (ePTFE) mesh with diaphragm implanted into the middle of the mesh. There were no immediate nor post-operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. CONCLUSION We present a novel and safe technique for combined chest wall and diaphragmatic resection following excision of an invading tumor while ensuring cosmesis and functionality of the ribcage as well as the diaphragm.
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Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
| | | | - Obada Al-Qudah
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Hanna Kakish
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Salam Elfar
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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Zapata González RA, Montoya Medina C, Vélez Castaño PA, Bedoya Muñoz LJ. Reconstrucción de pared torácica con material de fijación en pacientes con lesiones tumorales. Serie de casos. Rev Colomb Cir 2021. [DOI: 10.30944/20117582.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El manejo quirúrgico de las lesiones de la pared costal con resección y reconstrucción con material protésico ha venido en aumento, debido al avance en las técnicas quirúrgicas y en la experiencia del cirujano, así como en la innovación y las características de los materiales protésicos, que permiten realizar resecciones amplias de la pared garantizando una mayor estabilidad esquelética, una menor alteración de la mecánica respiratoria y mejores los resultados estéticos.
Métodos. Se presenta la experiencia en la clínica CardioVID, Medellín, Colombia, entre los años 2015 y 2019, mediante una revisión retrospectiva de 8 casos sometidos a resección de lesiones benignas de la pared torácica y reconstrucción con material protésico.
Resultados. Se encontró una adecuada evolución de los pacientes, con un buen resultado estético y funcional, con adecuado control de la enfermedad, sin reportes de complicaciones ni de recidiva en el seguimiento.
Discusión. Una técnica adecuada permite la reconstrucción de estos defectos con complicaciones mínimas y bajas tasas de extracción de prótesis, finalizando con excelentes resultados funcionales y cosméticos.
Con nuestra experiencia podemos concluir que la elección adecuada de los pacientes candidatos a manejo quirúrgico, una buena técnica quirúrgica y un personal con experiencia son cruciales para lograr buenos resultados en cuanto a función pulmonar y estética. Además de lograr una sobrevida bajo los parámetros establecidos posterior a lograr una resección R0.
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Wang W, Liang Z, Yang S, Feng Q, Nie X, Su G, Yuan W, Han Y. Three-dimensional (3D)-printed titanium sternum replacement: A case report. Thorac Cancer 2020; 11:3375-3378. [PMID: 33015990 PMCID: PMC7606024 DOI: 10.1111/1759-7714.13655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
After sternal tumor resection, reconstruction of chest wall defects is still a challenging part of thoracic surgery. Three-dimensional (3D)-printed titanium alloy prosthesis implants provide an effective solution. The bionic bone trabecular micropore structure, which is beneficial to the human body, increases stability and robustness of the prosthesis. Here, we report a successful case of a customized prosthesis using a 3D-printed titanium alloy to repair and reconstruct bone defects in a patient with sternal osteosarcoma who underwent radical resection of the whole sternum.
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Affiliation(s)
| | - Zhaoru Liang
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Shiyan Yang
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Qing Feng
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Xuewei Nie
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Guang Su
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Wenjie Yuan
- Yanda Hospital, Hebei Medical UniversitySanheChina
| | - Yi Han
- Yanda Hospital, Hebei Medical UniversitySanheChina
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Abstract
Dermato-fibro-sarcomas are known for high-recurrence rates. The gold standard of management is surgical excision with clear margins. Such margins on the chest results in large defects which require complex reconstructive procedures. We report a case series of patients managed by a multidisciplinary team with good outcomes. A total of 12 patients with extensive dermato-fibro-sarcoma of the anterior chest wall were treated over a period of 5 years in our setting. The age range was 25 to 54 years. Skeletal defects were reconstructed with Prolene mesh and methyl acrylate cement in 10 of the 12 patients. Pedicle flaps were used in nine patients. All margins were clear of tumors, with the nearest margin being 1.5 cm. One patient had a recurrence. No donor-site morbidity was recorded in any of the patients. In conclusion, a multidisciplinary approach provides improved outcomes in the management of large dermato-fibro-sarcomas of the chest wall. With this approach, extensive dissection of the tumor is achieved, and reconstruction is performed with minimal complication.
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Affiliation(s)
| | - M Muhinga
- Department of Surgery, University of Nairobi, Nairobi, Kenya
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Dharmaraj B, Diong NC, Shamugam N, Sathiamurthy N, Mohd Zainal H, Chai SC, Koh KL, Mat Zain MA, Haji Basiron N. Chest wall resection and reconstruction: a case series of 20 patients in Hospital Kuala Lumpur, Malaysia. Indian J Thorac Cardiovasc Surg 2020; 37:82-88. [PMID: 33442211 DOI: 10.1007/s12055-020-00972-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022] Open
Abstract
Chest wall resection is defined as partial or full-thickness removal of the chest wall. Significant morbidity has been recorded, with documented respiratory failure as high as 27%. Medical records of all patients who had undergone chest wall resection and reconstruction were reviewed. Patients' demographics, length of surgery, reconstruction method, size of tumor and chest wall defect, histopathological result, complications, duration of post-operative antibiotics, and hospital stay were assessed. From 1 April 2017 to 30 April 2019, a total of 20 patients underwent chest wall reconstructive surgery. The median age was 57 years, with 12 females and 8 males. Fourteen patients (70%) had malignant disease and 6 patients (30%) had benign disease. Nine patients underwent rigid reconstruction (titanium mesh for sternum and titanium plates for ribs), 6 patients had non-rigid reconstruction (with polypropylene or composite mesh), and 5 patients had primary closure. Nine patients (45%) required closure with myocutaneous flap. Complications were noted in 70% of patients. Patients who underwent primary closure had minor complications. In total, 66.7% of patients who had closure with either fasciocutaneous or myocutaneous flaps had threatened flap necrosis. Two patients developed pneumonia and 3 patients (15%) had respiratory failure requiring tracheostomy and prolonged ventilation. There was 1 mortality (5%) in this series. In conclusion, chest wall resections involving large defects require prudent clinical judgment and multidisciplinary assessments in determining the choice of chest wall reconstruction to improve outcomes.
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Affiliation(s)
- Benedict Dharmaraj
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Nguk Chai Diong
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Navindra Shamugam
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Narasimman Sathiamurthy
- Thoracic Surgery Unit, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Hamidah Mohd Zainal
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Siew Cheng Chai
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Khai Luen Koh
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mohammad Ali Mat Zain
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Normala Haji Basiron
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Rini IS, Krisna MA, Kamayana J, Djarot KR, Gunardi AJ. Keystone Perforator Island Flap for Postmastectomy Defect Resurfacing in Late-stage Breast Cancer Patients. Plast Reconstr Surg Glob Open 2019; 7:e2457. [PMID: 31942283 DOI: 10.1097/GOX.0000000000002457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Late-stage breast cancer usually presents with locally advanced disease, with or without metastasis. The primary tumor is typically large with skin infiltration which affects quality of life. Surgical resection will result in an extensive defect which potentially deteriorates patients’ quality of life if not properly managed. Keystone perforator island flap (KPIF) is a local advancement flap based on multiple perforators which can be a reliable reconstructive method to close an extensive defect.
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Scarnecchia E, Liparulo V, Capozzi R, Ceccarelli S, Puma F, Vannucci J. Chest wall resection and reconstruction for tumors: analysis of oncological and functional outcome. J Thorac Dis 2018; 10:S1855-S1863. [PMID: 30026972 DOI: 10.21037/jtd.2018.05.191] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Tumors of the chest wall have a large spectrum of well-assessed indications for resection. However, whether a reconstruction is required or not is not always clear. Complications after chest wall resection and reconstruction (CWRR) are described in literature and potentially severe. There is no evidence of how non-reconstructive management may influence the post-operative complication rate. Methods A total of 71 patients underwent thoracic demolition for tumors between April 2000 and October 2016. The patients were divided into two groups based on pathological findings: group 1: primary chest wall tumors; group 2: non-small cell lung cancer (NSCLC) invading the thoracic wall. They were then retrospectively analyzed by means of following criteria: TNM staging, histology, infiltration depth, 5-year survival, overall survival (OS), disease-free survival (DFS), relapse rate, R-0 resection, number of resected ribs, site of surgical resection and post-operative respiratory complications, flail chest, chronic pain, deformity of the chest wall and cosmetic results. Results Five-year survival, OS, DFS and risk of relapse showed a significant correlation with the presence of free surgical margins in both groups. In group 2, another parameter which correlated to survival, risk of relapse and DFS was lymph-nodal status. Moreover, the risk of post-operative respiratory complications was directly correlated with non-reconstruction after demolition of the chest wall in certain topographical sites. Conclusions free surgical margins are the main oncological prognostic factor in these patients. In patients who underwent resection of two or more ribs in a critical area, reconstruction of the bony thorax can significantly reduce the post-operative respiratory complication rate.
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Affiliation(s)
- Elisa Scarnecchia
- Department of Thoracic Surgery, University of Perugia medical School, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Valeria Liparulo
- Department of Thoracic Surgery, University of Perugia medical School, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Rosanna Capozzi
- Department of Thoracic Surgery, University of Perugia medical School, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Silvia Ceccarelli
- Department of Thoracic Surgery, University of Perugia medical School, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Puma
- Department of Thoracic Surgery, University of Perugia medical School, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia medical School, Santa Maria della Misericordia Hospital, Perugia, Italy
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